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Kim EJ, Jeon HW, Kim TK, Baek SH, Yoon JU, Yoon JY. Optimal effect-site concentration of remifentanil for minimizing cardiovascular changes caused by fiberoptic nasotracheal intubation. J Dent Anesth Pain Med 2015; 15:221-227. [PMID: 28879283 PMCID: PMC5564158 DOI: 10.17245/jdapm.2015.15.4.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Endotracheal intubation induces clinically adverse cardiovascular changes. Various pharmacological strategies for controlling these responses have been suggested with opioids being widely administered. In this study, the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses to fiberoptic nasotracheal intubation was evaluated. METHODS Thirty patients, aged 18-63 years, scheduled for elective surgery were included. Anesthesia was induced with a propofol and remifentanil infusion via target-controlled infusion (TCI). Remifentanil infusion was initiated at 3.0 ng/mL, and the response of each patient determined the Ce of remifentanil for the next patient by the Dixon up-and-down method at an interval of 0.5 ng/mL. Rocuronium was administered after propofol and remifentanil reached their preset Ce; 90 seconds later fiberoptic nasotracheal intubation was initiated. Non-invasive blood pressure and heart rate (HR) were measured at pre-induction, the time Ce was reached, immediately before and after intubation, and at 1 and 3 minutes after intubation. The up-and-down criteria comprised a 20% change in mean blood pressure and HR between just prior to intubation and 1 minute after intubation. RESULTS The median effective effect-site concentration (EC50) of remifentanil was 3.11 ± 0.38 ng/mL by the Dixon's up-and-down method. From the probit analysis, the EC50 of remifentanil was 3.43 ng/mL (95% confidence interval, 2.90-4.06 ng/mL). In PAVA, the EC50 and EC95 of remifentanil were 3.57 ng/mL (95% CI, 2.95-3.89) and 4.35 ng/mL (95% CI, 3.93-4.45). No remifentanil-related complications were observed. CONCLUSIONS The EC50 of remifentanil for minimizing the cardiovascular changes and side effects associated with fiberoptic nasotracheal intubation was 3.11-3.43 ng/mL during propofol TCI anesthesia with a Ce of 4 ug/mL.
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Affiliation(s)
- Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
| | - Hyun-Wook Jeon
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
| | - Tae-Kyun Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung-Hoon Baek
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Uk Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Young Yoon
- Department of Dental Anesthesia and Pain Medicine, Pusan National University Dental Hospital, Dental Research Institute, Yangsan, Korea
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Jung KT, Kim HJ, Bae HS, Lee HY, Kim SH, So KY, Lim KJ, Yu BS, Jung JD, An TH, Park HC. Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium. Korean J Anesthesiol 2014; 67:175-80. [PMID: 25302093 PMCID: PMC4188762 DOI: 10.4097/kjae.2014.67.3.175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/09/2014] [Accepted: 06/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium. METHODS A total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 µg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation. RESULTS Incidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups. CONCLUSIONS It seems that remifentanil (1 µg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.
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Affiliation(s)
- Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hye Ji Kim
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyo Sung Bae
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyun Young Lee
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Keum Young So
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Kyung Jun Lim
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Byung Sik Yu
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Jong Dal Jung
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Tae Hun An
- Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hong Chan Park
- Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, Gwangju, Korea
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